Understanding Chronic Pain

Triavil

[From Chapter 7 of Understanding Chronic Pain]

Margaret was in her seventies, a graceful and beautiful person, but suffering head pain. Several years before she had experienced attacks of recurrent, brief, lancinating pains about her right eye. Tic douloureux (trigeminal neuralgia) occurs typically in midlife or later, and it has many causes, but it is often due to pressure on the gasserian ganglion by a dilated and tortuous carotid artery. The gasserian is like the dorsal root ganglion, only much larger. It houses the cells which receive sensation from the richly enervated face and head. Its irritation by a pounding artery could certainly be expected to produce pain. An operation to displace the artery away from the ganglion by placing a pledget between them was performed, and Margaret obtained relief from her tic pain. Then, years later, she developed recurrent pain, something like a tic, but not quite. Her pain was confined to the right upper face, but was more widespread and diffuse than before and much longer in duration, lasting an hour or even more. It recurred three or four times daily. It was hard to delineate with certainty the nature of her pain. It was clearly related in some manner to her prior tic, encompassing the same approximate anatomic area, but its duration was too long for a typical tic pain. In its repetitiveness and stereotyped nature, it was somewhat like migraine, but the recurrence, up to several times daily, was unusual for that disorder. Such frequency of recurrence does occur in that migraine variant known as cluster headaches, but that is a disease of middle-aged males and not elderly females. It is also a disease associated with certain stigmata that make it rather easy to identify. Margaret had none of these. She did not have cluster headaches. She did, however, have a remote history of very typical migraine. Her headaches lasted a day or two and occurred randomly through the course of her life but abated, as migraine often does, as she grew older. Margaret's face pain, I suspected, represented a hybrid of two different pains. It lasted too long for a tic, but was too short for a migraine. It had something of both. It was an incorporation of two separate painful memories, a melding of tic and migraine. This merging of pain syndromes, quite different in their etiology, but located in proximate areas of the body, is by no means uncommon. This should not surprise. Our memory is, after all, imperfect.

As Margaret had become painful she had also become depressed. Painfulness and depression frequently occur together. In her case, however, there may have been special meaning. Years before, when she was in her forties, she suffered a depression severe enough to require electroconvulsive therapy. I suspected that her depression represented the recrudescence of a remembered behavior. I was rather sure her face pain did.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:14 AM

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Memory The Painful Brain